Stay With Me!

The Explainer Question of the Year: Does shouting at an injured person have any medical benefit?

Last month the Explainer paused while packing up his things to ask if his faithful readers would help decide the final Question of the Year. Thousands of you sifted through the topics that this column was unable to address in 2013—a list of matters of minuscule importance, such as why venison is not usually made into soup, and when people started drinking beverages through straws. But these were just the also-rans. What were the runners-up?

In third place, with 8.1 percent of the votes, a question of meteorological anthropology: What did Native Americans think of tornadoes? This would have been a tricky one to answer, as some American Indians seemed to view them as a cleansing while others called them punishment.

In second place, with 8.7 percent, some cross-cultural lexicography: I love palindromes (“A man, a plan, a canal—Panama!”) but I’ve always had an English-centric view of them. What are some palindromes in other languages? What’s the easiest language for palindromes? Another question that doesn’t have an easy answer. As they say in Iceland, Amma sá Afa káfa af ákafa á Samma—“Grandma saw Grandpa enthusiastically groping Sammy.” Let’s leave it at that.

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And in first place by a wide margin, with 12.3 percent of the votes, our Explainer Question of the Year for 2013: Countless times in TV shows or movies, characters urge a wounded figure to stay with them, not to lose consciousness. Is there any medical basis for this? Doesn’t the body need to lose consciousness to cope with the emergency? Might these dramatic and good-hearted souls actually hasten the wounded character’s death?

The answer: No, no, and no. If someone’s about to fall into a coma, there’s nothing you can say to change his mind.

It may seem like unconsciousness would be a first step toward death, but that’s not really true. As a general rule, whatever underlying problem causes a loss of consciousness—whether it’s a stroke, a drug overdose, blood loss, or something else—will continue to unfold irrespective of a patient’s state of awareness. Keep him awake or let him sleep; it doesn’t matter much.

The only time that yelling might be useful is when doctors suspect that a patient might be faking, or that he is the victim of a psychogenic coma.

An unresponsive patient may face some special risks, however. The muscles of the airway can relax in such a way as to hinder breathing, or a patient might be suffocated by his floppy tongue, or by having his neck tilted at a funny angle. ER doctors and technicians are trained to keep a victim’s airway clear. They may do this by inserting a tube into the trachea. They don’t do this by slapping a victim across the face or begging him to stay alert.

It’s often said that those who suffer head injuries should be kept awake by whatever means necessary, on the theory that dozing off could send them into a coma. Most doctors say that’s not the case at all. It might still be a good idea to rouse a patient from time to time and make sure that she’s still OK. When people are asleep, they have no clear way to register distress, so waking them periodically may be a useful way for those around them to know if things are getting worse.

Even if it were a good idea to keep a patient from losing consciousness, it’s not clear how that could be accomplished. Spoken pleas won’t have a significant effect, nor will you gain much ground by calling your loved one a “bitch” and telling her to "fight, goddammit, fight!" (See the video clip below.) Other, more aggressive forms of stimulation might work a little better. When an ER doctor slides a tube into a wounded patient’s trachea, her eyes might snap open for second, and her breathing could be restored. But so far as doctors know, the jolt wouldn’t last.

The only time that yelling might be useful is when doctors suspect that a patient might be faking, or that he is the victim of a psychogenic coma. If he responds to a loud noise, then he’s not really unconscious.

“Stay with me” does make for dramatic scenes in movies, though, science notwithstanding. In 2006, a pair of researchers in neurology at the Mayo Clinic reviewed several dozen Hollywood films going back to 1970 to see how comas were portrayed. They found numerous inaccuracies, including what they called the “Sleeping Beauty phenomenon”: Patients appeared to be sleeping peacefully, with their eyes closed and otherwise in good health. (In real life, comatose patients often have a feeding tube or tracheotomy, as well as permanent muscular contractions that can make the body look deformed.) Of the movies they considered, just 7 percent gave a “reasonably accurate presentation of prolonged coma.”